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|A Short Bipolar Disorder Summary|
|Bipolar disorder, is a serious brain disorder. Also known as manic-depressive illness, it is a mental illness involving episodes of serious mania and depression. The person’s mood usually swings from overly “high” and irritable to sad and hopeless, and then back again, with periods of normal mood in between.
Bipolar disorder typically begins in adolescence or early adulthood and continues throughout life. It is often not recognized as an illness and people who have it may suffer needlessly for years or even decades.
Effective treatments are available that greatly alleviate the suffering caused by bipolar disorder and can usually prevent its devastating complications. These include marital breakups, job loss, alcohol and drug abuse, and suicide.
Facts about bipolar disorder:
Signs and Symptoms
It may be helpful to think of the various mood states in manic-depressive illness as a spectrum or continuous range. At one end is severe depression, which shades into moderate depression; then come mild and brief mood disturbances that many people call “the blues”, then normal mood, then hypomania (a mild form of mania), and then mania.
Recognition of the various mood states is essential so that the person who has manic-depressive illness can obtain effective treatment and avoid the harmful consequences of the disease, which include destruction of personal relationships, loss of employment, and suicide.
Manic-depressive illness is often not recognized by the patient, relatives, friends, or even physicians.
An early sign of manic-depressive illness may be hypomania–a state in which the person shows a high level of energy, excessive moodiness or irritability and impulsive or reckless behavior.
Hypomania may feel good to the person who experiences it. Thus even when family and friends learn to recognize the mood swings the individual often will deny that anything is wrong.
In its early stages bipolar disorder may masquerade as a problem other than mental illness. For example, it may first appear as alcohol or drug abuse, or poor school or work performance.
If left untreated, bipolar disorder tends to worsen and the person experiences episodes of full-fledged mania and clinical depression.
Descriptions offered by patients themselves offer valuable insights into the various mood states associated with bipolar disorder:
Almost all people with bipolar disorder–even those with the most severe forms–can obtain substantial stabilization of their mood swings.
One medication, lithium, is usually very effective in controlling mania and preventing the recurrence of both manic and depressive episodes.
More recently, the mood-stabilizing anticonvulsants carbamazepine and valproate have also been found useful especially in more refractory bipolar episodes. Often these medications are combined with lithium for maximum effect.
Some scientists have theorized that the anticonvulsant medications work because they have an effect on kindling, a process in which the brain becomes increasingly sensitive to stress and eventually begins to show episodes of abnormal activity even in the absence of a stressor. It is thought that lithium acts to block the early stages of this kindling process and that carbamazepine and valproate act later. Valproate has recently been approved by the Food and Drug Administration for treatment of acute mania.
Children and adolescents with bipolar disorder are generally treated with lithium, but carbamazepine and valproate are also used.
The high potency benzodiazepines; clonazepam and lorazepam may be helpful adjuncts for insomnia.
Thyroid augmentation may also be of value.
For depression, several types of antidepressants can be useful when combined with lithium, carbamazepine or valproate.
Electroconvulsive therapy (ECT) is often helpful in the treatment of severe depression and/or mixed mania that does not respond to medications.
As an adjunct to medications, psychotherapy is often helpful in providing support, education, and guidance to the patient and his or her family.
Constructing a life chart of mood symptoms, medications, and life events may help the health care professional to treat the illness optimally.
Because manic-depressive illness is recurrent, long-term preventive (prophylactic) treatment is highly recommended and almost always indicated.
Some people with untreated bipolar disorder have repeated depressions and only an occasional episode of hypomania (bipolar II). In the other extreme, mania may be the main problem and depression may occur only infrequently. In fact, symptoms of mania and depression may be mixed together in a single bipolar state.
This information has been excerpted from material developed by the National Institute for Mental Health.
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Lee Thompson Young suffered from bipolar disorder, coroner says
LOS ANGELES, Oct. 10 (UPI) – Lee Thompson Young suffered from bipolar disorder and depression before he fatally shot himself in August, the Los Angeles County coroner said.
The 29-year-old “Rizzoli & Isles” star was taking medication for bipolar disorder and depression when he killed himself. However, no traces of opiates, alcohol, cocaine or other drugs were found in his system, the New York Daily News reported.
Young shot himself in the right temple while sitting on the couch of his North Hollywood apartment. His body was discovered Aug. 19 after he failed to show up for work.
The actor’s specific motive remains unclear, the Daily News said.
The South Carolina native got his big break in acting on the Disney Channel series “The Famous Jett Jackson.”
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Alcoholism and Psychiatric Disorders
A Case Example
A 50–year–old man presents to the emergency room complaining: “I’m going to end it all . . . life’s just not worth living.” The clinician elicits an approximate 1–week history of depressed mood, feelings of guilt, and occasional suicidal ideas that have grown in intensity since the man’s wife left him the previous day. The client denies difficulty sleeping, poor concentration, or any changes in his appetite or weight prior to his wife’s departure. He appears unshaven and slightly unkempt, but states that he was able to go to work and function on the job until his wife left. The scent of alcohol is present on the man’s breath. When queried about this, he admits to having “a few drinks to ease the pain” earlier that morning, but does not expand on this theme. He seeks help for his low mood and demoralization, acknowledging later in the interview that “I really don’t want to kill myself; I just want my life back to the way it used to be.”
The above case is a composite of many clinical examples observed across mental health settings each day, illustrating the challenges clinicians face when evaluating psychiatric complaints in alcoholic patients. The questions facing the clinician in this example include:
Is the patient clinically depressed in the sense that he has a major depressive episode requiring aggressive pharmacological and psychosocial treatment?
What role, if any, is alcohol playing in the patient’s complaints?
How does one tease out whether drinking is the cause of the man’s mood problems or the result of them?
If the man’s condition is not a major depression, what is it, what is its likely course, and how can it be treated?
As is usually the case (Anthenelli 1997; Helzer and Przybeck 1988), the patient in this example does not volunteer his alcohol abuse history but comes to the hospital for help with his psychological distress. The acute stressor leading to the distress is his wife’s leaving him; only further probing during the interview uncovers that the reason for the wife’s action is the man’s excessive drinking and the effects it has had on their relationship and family. Thus, a clinician who lacks adequate training in this area or who carries too low a level of suspicion of alcohol’s influence on psychiatric complaints may not consider alcohol misuse as a contributing or causative factor for the patient’s psychological problems.
In general, it is helpful to consider psychiatric complaints observed in the context of heavy drinking as falling into one of three categories—alcohol–related symptoms and signs, alcohol–induced psychiatric syndromes, and independent psychiatric disorders that co–occur with alcoholism. These three categories are discussed in the following sections.
Alcohol–Related Psychiatric Symptoms and Signs
Heavy alcohol use directly affects brain function and alters various brain chemical (i.e., neurotransmitter) and hormonal systems known to be involved in the development of many common mental disorders (e.g., mood and anxiety disorders) (Koob 2000). Thus, it is not surprising that alcoholism can manifest itself in a broad range of psychiatric symptoms and signs. (The term “symptoms” refers to the subjective complaints a patient describes, such as sadness or difficulty concentrating, whereas the term “signs” refers to objective phenomena the clinician directly observes, such as fidgeting or crying.) In fact, such psychiatric complaints often are the first problems for which an alcoholic patient seeks help (Anthenelli and Schuckit 1993; Helzer and Przybeck 1988). The patient’s symptoms and signs may vary in severity depending upon the amounts of alcohol used, how long it was used, and how recently it was used, as well as on the patient’s individual vulnerability to experiencing psychiatric symptoms in the setting of excessive alcohol consumption (Anthenelli and Schuckit 1993; Anthenelli 1997). For example, during acute intoxication, smaller amounts of alcohol may produce euphoria, whereas larger amounts may be associated with more dramatic changes in mood, such as sadness, irritability, and nervousness. Alcohol’s disinhibiting properties may also impair judgment and unleash aggressive, antisocial behaviors that may mimic certain externalizing disorders, such as antisocial personality disorder (ASPD) (Moeller et al. 1998). (Externalizing disorders are discussed in the section “ASPD and Other Externalizing Disorders.”) Psychiatric symptoms and signs also may vary depending on when the patient last used alcohol (i.e., whether he or she is experiencing acute intoxication, acute withdrawal, or protracted withdrawal) and when the assessment of the psychiatric complaints occurs. For instance, an alcohol–dependent patient who appears morbidly depressed when acutely intoxicated may appear anxious and panicky when acutely withdrawing from the drug (Anthenelli and Schuckit 1993; Anthenelli 1997).
In addition to the direct pharmacological effects of alcohol on brain function, psychosocial stressors that commonly occur in heavy–drinking alcoholic patients (e.g., legal, financial, or interpersonal problems) may indirectly contribute to ongoing alcohol–related symptoms, such as sadness, despair, and anxiety (Anthenelli 1997; Anthenelli and Schuckit 1993).
Alcohol–Induced Psychiatric Syndromes
It is clinically useful to distinguish between assorted commonly occurring, alcohol–induced psychiatric symptoms and signs on the one hand and frank alcohol–induced psychiatric syndromes on the other hand. A syndrome generally is defined as a constellation of symptoms and signs that coalesce in a predictable pattern in an individual over a discrete period of time. Such syndromes largely correspond to the sets of diagnostic criteria used for classifying mental disorders throughout the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM–IV) (American Psychiatric Association [APA] 1994) and its successor, the DSM–IV Text Revision (DSM–IV–TR) (APA 2000).
Publication of the DSM–IV marked the first time that clinicians could specifically diagnose several “alcohol–induced disorders” rather than having to lump alcohol–related conditions under the more generic rubric of an “organic mental syndrome” (Anthenelli 1997). Given the broad range of effects heavy drinking may have on psychological function, these alcohol–induced disorders span several categories of mental disorders, including mood, anxiety, psychotic, sleep, sexual, delirious, amnestic, and dementia disorders. According to the DSM–IV, the essential feature of all these alcohol–induced disorders is the presence of prominent and persistent symptoms, which are judged—based on their onset and course as well as on the patient’s history, physical exam, and laboratory findings—to be the result of the direct physiological effects of alcohol. To be classified as alcohol–induced disorders, these conditions also must occur within 4 weeks of the last use of or withdrawal from alcohol and should be of clinical significance beyond what is expected from typical alcohol withdrawal or intoxication (APA 1994).
The diagnostic criteria of the DSM–IV and DSM–IV–TR do not clearly distinguish between alcohol–related psychiatric symptoms and signs and alcohol–induced psychiatric syndromes. Instead, these criteria sets state more broadly that any alcohol–related psychiatric complaint that fits the definition given in the paragraph above and which “warrants independent clinical attention” be labeled an alcohol–induced disorder (APA 1994, 2000). In other words, alcohol–related psychiatric symptoms and signs can be labeled an alcohol–induced psychiatric disorder in DSM–IV or DSM–IV–TR without qualifying as syndromes.
Alcohol–induced psychiatric disorders may initially be indistinguishable from the independent psychiatric disorders they mimic. However, what differentiates these two groups of disorders is that alcohol–induced disorders typically improve on their own within several weeks of abstinence without requiring therapies beyond supportive care (Anthenelli and Schuckit 1993; Anthenelli 1997; Brown et al. 1991, 1995). Thus, the course and prognosis of alcohol–induced psychiatric disorders are different from those of the independent major psychiatric disorders, which are discussed in the next section.
Alcoholism with Comorbid, Independent Psychiatric Disorders
Alcoholism is also associated with several psychiatric disorders that develop independently of the alcoholism and may precede alcohol use and abuse. These independent disorders may make certain vulnerable patients more prone to developing alcohol–related problems (Helzer and Przybeck 1988; Kessler et al. 1997; Schuckit et al. 1997b). One of the most common of these comorbid conditions is ASPD, an axis II personality disorder1 (1The DSM–IV classifies mental disorders along several levels, or axes. In this classification, axis II disorders include personality disorders, such as ASPD or obsessive–compulsive disorder, as well as mental retardation; axis I disorders include all other mental disorders, such as anxiety, eating, mood, psychotic, sleep, and drug–related disorders.) marked by a longstanding pattern of irresponsibility and violating the rights of others that generally predates the problems with alcohol. Axis I disorders commonly associated with alcoholism include bipolar disorder, certain anxiety disorders (e.g., social phobia, panic disorder, and post–traumatic stress disorder [PTSD]), schizophrenia, and major depression (Helzer and Przybeck 1988; Kessler et al. 1997). (Several of these common comorbid disorders are reviewed in detail in other articles of this journal issue.) It is important for clinicians to know which disorders are most likely to coexist with alcoholism so that they may specifically probe for these conditions when evaluating the patient’s complaints.
PSYCHIATRIC DISORDERS COMMONLY ASSOCIATED WITH ALCOHOLISM
Independent Major Depression
Mood disturbances (which frequently are not severe enough to qualify as “disorders”) are arguably the most common psychiatric complaint among treatment–seeking alcoholic patients, affecting upwards of 80 percent of alcoholics at some point in their drinking careers (Brown and Schuckit 1988; Anthenelli and Schuckit 1993). In keeping with the three broad categories described above into which such complaints may fall, mood problems may be characterized as one of the following:
An expected, time–limited consequence of alcohol’s depressant effects on the brain
A more organized constellation of symptoms and signs (i.e., a syndrome) reflecting an alcohol–induced mood disorder with depressive features
An independent major depressive disorder coexisting with or even predating alcoholism.
When one applies these more precise definitional criteria and classifies only those patients as depressive who meet the criteria for a syndrome of a major depressive episode, approximately 30 to 40 percent of alcoholics experience a comorbid depressive disorder (Anthenelli and Schuckit 1993; Schuckit et al. 1997a).
Some controversy exists as to the precise cause–and–effect relationship between depression and alcoholism, with some authors pointing out that depressive episodes frequently predate the onset of alcoholism, especially in women (Kessler et al. 1997; Helzer and Przybeck 1988; Hesselbrock et al. 1985). Several studies found that approximately 60 percent of alcoholics who experience a major depressive episode, especially men, meet the criteria for an alcohol–induced mood disorder with depressive features (Schuckit et al. 1997a; Davidson 1995). The remaining approximately 40 percent of alcoholic women and men who suffer a depressive episode likely have an independent major depressive disorder—that is, they experienced a major depressive episode before the onset of alcoholism or continue to exhibit depressive symptoms and signs even during lengthy periods of abstinence.
In a study of 2,954 alcoholics, Schuckit and colleagues (1997a) found that patients with alcohol–induced depression appear to have different characteristics from patients with independent depressive disorders. For example, compared with patients with alcohol–induced depression, patients with independent depression were more likely to be Caucasian, married, and female; less experienced with other illicit drugs; less often treated for alcoholism; more likely to have a history of a prior suicide attempt; and more likely to have a family history of a major mood disorder.
According to two major epidemiological surveys conducted in the past 20 years (Helzer and Przybeck 1988; Kessler et al. 1997), bipolar disorder (i.e., mania or manic–depressive illness) is the second–most common axis I disorder associated with alcohol dependence.2 (2 The axis I disorders most commonly associated with alcoholism are other drug use disorders.) Among manic patients, 50–60 percent abuse or become dependent on alcohol or other drugs (AODs) at some point in their illness (Brady and Sonne 1995). Diagnosing bipolar disorder in alcoholic patients can be particularly challenging. Several factors, such as the underreporting of symptoms (particularly symptoms of mania), the complex effects of alcohol on mood states, and common features shared by both illnesses (e.g., excessive involvement in pleasurable activities with high potential for painful consequences) reduce diagnostic accuracy. Bipolar patients are also likely to abuse drugs other than alcohol (e.g., stimulant drugs such as cocaine or methamphetamine), further complicating the diagnosis. As will be described in greater detail later, it can be helpful for an accurate diagnosis to obtain a careful history of the chronological order of both illnesses because approximately 60 percent of patients with both alcoholism and bipolar disorder started using AODs before the onset of affective episodes (Strakowski et al. 2000).
Overall, anxiety disorders do not seem to occur at much higher rates among alcoholics than among the general population (Schuckit and Hesselbrock 1994). For example, results from the Epidemiologic Catchment Area survey indicated that among patients who met the lifetime diagnosis of alcohol abuse or dependence, 19.4 percent also carried a lifetime diagnosis of any anxiety disorder. This corresponds to only about 1.5 times the rate for anxiety disorders in the general population (Regier et al. 1990; Kranzler 1996). Specific anxiety disorders, such as panic disorder, social phobia, and PTSD, however, appear to have an increased co–occurrence with alcoholism (Schuckit et al. 1997b; Kranzler 1996; Brady et al. 1995).
As with alcohol–induced depression, it is important to differentiate alcohol–induced anxiety from an independent anxiety disorder. This can be achieved by examining the onset and course of the anxiety disorder. Thus, symptoms and signs of alcohol–induced anxiety disorders typically last for days to several weeks, tend to occur secondary to alcohol withdrawal, and typically resolve relatively quickly with abstinence and supportive treatments (Kranzler 1996; Brown et al. 1991). In contrast, independent anxiety disorders are characterized by symptoms that predate the onset of heavy drinking and which persist during extended sobriety.
ASPD and Other Externalizing Disorders
Among the axis II personality disorders, ASPD (and the related conduct disorder, which often occurs during childhood in people who subsequently will develop ASPD) has long been recognized to be closely associated with alcoholism (Lewis et al. 1983). Epidemiologic analyses found that compared with nonalcoholics, alcohol–dependent men are 4–8 times more likely, and alcoholic women are 12–17 times more likely, to have comorbid ASPD (Helzer and Przybeck 1988; Kessler et al. 1997). Thus, approximately 15 to 20 percent of alcoholic men and 10 percent of alcoholic women have comorbid ASPD, compared with 4 percent of men and approximately 0.8 percent of women in the general population. Patients with ASPD are likely to develop alcohol dependence at an earlier age than their nonantisocial counterparts and are also more prone to having other drug use disorders (Cadoret et al. 1984; Anthenelli et al. 1994).
In addition to ASPD, other conditions marked by an externalization of impulsive aggressive behaviors, such as attention deficit hyperactivity disorder (ADHD) (Sullivan and Rudnik–Levin 2001), are also associated with increased risk of alcohol–related problems. (For more information on the relationship between alcoholism and ADHD, see the article by Smith and colleagues, pp. 122–129.)
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Bipolar II Disorder
What Is Bipolar II Disorder?
However, in bipolar II disorder, the “up” moods never reach full-on mania. The less-intense elevated moods in bipolar II disorder are called hypomanic episodes, or hypomania.
A person affected by bipolar II disorder has had at least one hypomanic episode in life. Most people with bipolar II disorder also suffer from episodes of depression. This is where the term “manic depression” comes from.
In between episodes of hypomania and depression, many people with bipolar II disorder live normal lives.
Who Is at Risk for Bipolar II Disorder?
Virtually anyone can develop bipolar II disorder. About 2.5% of the U.S. population suffers from some form of bipolar disorder – nearly 6 million people.
Most people are in their teens or early 20s when symptoms of bipolar disorder first start. Nearly everyone with bipolar II disorder develops it before age 50. People with an immediate family member who have bipolar are at higher risk.
What Are the Symptoms of Bipolar II Disorder?
During a hypomanic episode, elevated mood can manifest itself as either euphoria (feeling “high”) or as irritability.
Symptoms during hypomanic episodes include:
- Flying suddenly from one idea to the next
- Rapid, “pressured,” and loud speech
- Increased energy, with hyperactivity and a decreased need for sleep
People experiencing hypomanic episodes are often quite pleasant to be around. They can often seem like the “life of the party” — making jokes, taking an intense interest in other people and activities, and infecting others with their positive mood.
What’s so bad about that, you might ask? Hypomania can also lead to erratic and unhealthy behavior. People in hypomanic episodes might spend money they don’t have, seek out sex with people they normally wouldn’t, and engage in other impulsive or risky behaviors.
Also, the vast majority of people with bipolar II disorder experience significant depressive episodes. These can occur soon after hypomania subsides, or much later. Some people cycle back and forth between hypomania and depression, while others have long periods of normal mood in between episodes.
Untreated, an episode of hypomania can last anywhere from a few days to several months. Most commonly, symptoms continue for a few weeks to a few months.
Depressive episodes in bipolar II disorder are similar to “regular” clinical depression, with depressed mood, loss of pleasure, low energy and activity, feelings of guilt or worthlessness, and thoughts of suicide. Depressive symptoms of bipolar disorder can last weeks, months, or rarely years.
What Are the Treatments for Bipolar II Disorder?
Hypomania often masquerades as happiness and relentless optimism. When hypomania is not causing unhealthy behavior, it often may go unnoticed and therefore remain untreated. This is in contrast to true mania, which by definition causes problems in functioning and requires treatment with medications.
People with bipolar II disorder can benefit from preventive drugs that level out moods over the long term. These prevent the negative consequences of hypomania, and also help to prevent episodes of depression.
Lithium: This simple metal in pill form is highly effective at controlling mood swings (particularly highs) in bipolar disorder. Lithium has been used for more than 60 years to treat bipolar disorder. Lithium can take weeks to work fully, making it better for long-term treatment than for acute hypomanic episodes. Blood levels of lithium and other laboratory tests (such as kidney and thyroid functioning) must be monitored periodically to avoid side effects.
Depakote: This antiseizure drug also works to level out moods. It has a more rapid onset of action than lithium, and it can also be used for prevention.
Lamictal: This drug is approved by the FDA for the maintenance treatment of adults with bipolar disorder. It has been found to help delay bouts of mood episodes of depression, mania, hypomania (a milder form of mania), and mixed episodes in people being treated with standard therapy.
Some other antiseizure medications, such as Tegretol and Trileptal are also sometimes prescribed.
By definition, hypomanic episodes do not involve psychosis and do not interfere with functioning. Antipsychotic drugs, such as Abilify, Risperdal, Seroquel and others, are nevertheless sometimes used in hypomania and some (notably, Seroquel) are used for depression in bipolar II disorder.
This class of drugs includes Xanax, Ativan, and Valium and is commonly referred to as tranquilizers. They are used for short-term control of acute symptoms associated with hypomania such as insomnia or agitation.
Seroquel and Seroquel XR are the only medications FDA-approved specifically for bipolar II depression. Common antidepressants such as Prozac, Zoloft, and Paxilare also sometimes used in bipolar II depression, and are thought to be less likely to cause or worsen hypomania than is the case in bipolar I disorder. Other medicines sometimes used to treat bipolar II depression include mood stabilizers such as lithium or Depakote, and occasionally Lamictal (although the proven value of Lamictal in bipolar disorder is stronger for preventing relapses than treating acute episodes of bipolar depression). Psychotherapy, such as cognitive-behavioral therapy, may also help.
Because bipolar II disorder typically involves recurrent episodes, continuous and ongoing treatment with medicines is often recommended for relapse prevention.
Can Bipolar II Disorder Be Prevented?
The causes of bipolar disorder are not well understood. It’s not known if bipolar II disorder can be prevented entirely.
It is possible to prevent some episodes of hypomania or depression, once bipolar disorder has developed. Regular therapy sessions with a psychologist or social worker can stabilize mood, leading to fewer hospitalizations and feeling better overall. Taking medicine on a regular basis also leads to fewer hypomanic or depressive episodes.
How Is Bipolar II Disorder Different From Other Types of Bipolar Disorder?
People with bipolar I disorder experience true mania — a severe, abnormally elevated mood with erratic behavior. Manic symptoms lead to serious disruptions in life, causing legal or major personal problems.
In bipolar II disorder, the symptoms of elevate mood never reach full-on mania. Hypomania in bipolar II is a milder form of mood elevation. However, the depressive episodes of bipolar II disorder are often longer-lasting and may be even more severe than in bipolar I disorder. Therefore, bipolar II disorder is not simply a “milder” overall form of bipolar disorder.
Buying Health Insurance as an Individual
Look for other access to insurance
If you do not have access to any employer-based insurance, do you belong to or could you join any group or association that might offer you a discount on health insurance? Keep in mind that some of these plans may have limited coverage, so make sure you know exactly what you are getting.
Affordable Care Act
Information for Wisconsin about the Health Insurance Marketplace under the Affordable Care Act is available from HealthCare.gov. The Health Insurance Marketplace is a new way to get coverage that meets your needs. Starting October 1, 2013, you can come to HealthCare.gov to fill out an application and see your plan choices. In the meantime, this site will help you get ready. More information from HealthCare.gov.
Health savings accounts
There are several types of health spending accounts on the market today. Health Savings Accounts (HSAs) are one type of health spending account.Information on HSAs is available.
Your rights and obligations
Finding insurance as an individual means special concerns, including generally higher costs and less complete coverage. In addition, your health can affect the type of coverage you can get. Before you can buy an individual policy you must give the insurance company information about your health. This process is called medical underwriting.
Some things to look out for
As the cost of health care rises, health insurance scams are becoming more common. Watch out for unlicensed insurers that offer cheap coverage but then refuse to pay claims. Also be wary of so-called “discount health plans” that are not really insurance at all, but advertise in ways that make it sound as if they are. When in doubt, contact Wisconsin’s Office of the Commissioner of Insurance at (608) 266-3585 (from Madison) or (800) 236-8517 to confirm that you are working with a licensed insurer. Remember, if it sounds too good to be true, it probably is.
- Don’t Be a Victim of Unlicensed Insurers: This information from the Wisconsin Office of the Commissioner of Insurance (OCI) can help you avoid the pitfall of purchasing a plan that is not licensed in the state of Wisconsin. OCI also offers a searchable directory of insurers licensed in the state of Wisconsin.
- Beware of Discount Health Plans: Information from OCI.
- OCI warns about a rise in fake insurance policies and what you can do to protect yourself. The OCI urges consumers to STOP before signing anything or writing a check, CALL the OCI at 1-800-236-8517, and CONFIRM that the company is licensed to do business in Wisconsin.
- More tips to protect yourself against illegal health plans (PDF, 27 KB) and deceptive sales practices (PDF, 26 KB) are available from the National Association of Insurance Commissioners.
- The FBI offers ways to protect yourself against fraud, including health care fraud: Common Fraud Schemes. Scroll down to find tips for avoiding fraud in health care and health insurance.
- Fighting Health Care Fraud Toolbox from AHIP, the national trade association representing the health insurance industry, lists some ways consumers can protect themselves and their loved ones from health care fraud.
Tips on buying individual health coverage are provided by Insure.com.
Working with an agent
If you are trying to decide whether to work with an insurance agent or to contact the insurance companies directly, keep in mind that some insurance companies only work through agents/brokers while some agents only offer insurance for one or two insurance companies.
- Information about finding an agent may be available from the National Association of Insurance and Financial Advisors (NAIFA), a group representing insurance professionals. You can also try the Independent Insurance Agents of Wisconsin.
- If you decide to work with one or more agents, check the OCI website to be sure their licenses are currently active.
Buying insurance on the Internet
There are several commercial tools such as Insure.com, eHealthinsurance.com, and healthcareshopper.com available on the Internet that provide instant insurance quotes. Before you use this approach, consider the precautions (PDF, 27 KB) suggested by the National Association of Insurance Commissioners.
Finding insurance options under the Affordable Care Act
- Information for Wisconsin about the Health Insurance Marketplace under the Affordable Care Act is available from HealthCare.gov. The Health Insurance Marketplace is a new way to get coverage that meets your needs. Starting October 1, 2013, you can come to HealthCare.gov to fill out an application and see your plan choices. In the meantime, this site will help you get ready. More information from HealthCare.gov.